With Business Intelligence in Healthcare, Can Medicaid Costs be Manageable?

Medicaid Expansion was included as an option to the Affordable Care Act and many states accepted the offer from the Federal Government to expand Medicaid coverage to citizens who did not qualify previously because their incomes were over 100% of the Federal Poverty level. In Colorado, coverage under Medicaid extends to people who have incomes up to 138% of the poverty level. While this coverage will be funded by Federal funds for three years, states still face major cost challenges with expanded Medicaid rolls.

In Colorado, we have added over 150,000 people to our Medicaid rolls already and more are likely. It has been speculated, very conservatively, that the cost of Medicaid will increase by 213% over 10 years and that is not something this, or any other state can absorb, without serious consequences. The downward pressure on costs will extend to hospitals and physician providers as it always does. The question is how do we deal with this pending situation?

Don’t let business intelligence in healthcare get in the way of physicians’ observations

New Yorker magazine published a story titled “The Hot Spotters” in January 24, 2011. The article was subtitled “Can we lower medical costs by giving the neediest patients better care?” The point of the article was to identify the costliest patients and then single them out for better, and more proactive care. Dr. Jeffrey Brenner, in Camden NJ, believed that if he could figure out which patients were costing the most, he could single them out and reduce their overall costs. From the article; he found that between January of 2002 and June of 2008 some 900 people in two buildings accounted for more than 4,000 hospital visits and about $200 million in health-care bills. One patient had 324 admissions in five years. The most expensive patient cost insurers $3.5 million.

Brenner knew he needed data but his perspective on technology being used to deliver it was not all that positive; “For all the stupid, expensive, predictive-modeling software that the big venders sell,” he says, “you just ask the doctors, ‘Who are your most difficult patients?, and they can identify them.” Brenner successfully saved Camden millions of dollars. The question is, what did he really get with the data and how can we positively apply business intelligence in healthcare to mitigate challenges with Medicaid Expansion today.

Combining patient knowledge with business intelligence in healthcare can lead to desirable outcomes

Dr. Brenner was far more successful when he got to know patients and their daily habits. We refer to this as their psychosocial behaviors. We know when patients have chronic diseases and we know what we would like them to do to improve their health outcomes but in many cases it is their behaviors that determine their success rate. Do they walk by a doughnut vendor on the way to the lab every time they need a lab test and end up buying a few donuts in the process? Do the patients with liver disease live next to a friendly neighbor who offers them a couple of beers every night? We know these affect outcomes and the question is whether or not we can capture these psychosocial behaviors within our IT systems, combine them with other data points and can this accumulation of rich business intelligence in healthcarethen allow us to be far more proactive as Dr. Brenner was in making a difference in their care.

Quality business intelligence in healthcare delivers outcomes you can use

At Orchestrate Healthcare we deliver outcomes through our Business Intelligence consulting services. We believe the future of proactive patient care demands that we customize EMR applications, HIE, Analytics Solutions, and interfaces through interface engines to help our customers and citizens proactively improve the cost and quality of care.

Let’s discuss your healthcare situation, and see how we can help you make a difference and meet the challenge of cost and quality in the cost-pressured environment with Medicaid expansion going forward. Call us at (877) 303-3377 or contact us to learn more.